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Congressman Adrian Smith

Representing the 3rd District of Nebraska

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Increasing Rural Access to Healthcare

February 22, 2019
Column

Access to quality healthcare is among the most important issues facing the country today, especially for aging Americans. In rural areas, such as Nebraska’s Third District, this is even more true. Nearly 50 million Americans, or one in seven, rely on Medicare for their healthcare needs in retirement or when disabled. The House Ways and Means Subcommittee on Health, of which I am a member, is responsible for writing the policies which govern Medicare and ensuring it meets patients’ needs.

I’ve introduced two bipartisan measures so far this Congress to contribute to the goal of increasing rural access to health care. One of them, H.R. 1041, the Critical Access Hospital Relief Act, will repeal Medicare’s 96-hour rule, which requires hospitals either to discharge or transfer patients within four days of admittance. This arbitrary deadline amounts to an undue burden on both hospitals and patients in rural areas where hospitals are typically more distant from one another, forcing a choice between early discharge and a long, expensive transfer. While the Trump administration has provided temporary relief from this rule for rural hospitals, I hear regularly from administrators and practitioners that legislation is necessary to provide the long term certainty this regulation won’t return.

H.R. 1052, the Physician Assistant Direct Payment Act, will allow physician assistants to be directly compensated by Medicare in order to expand their role as medical providers in underserved communities. At present, physician assistants are allowed to bill Medicare for services rendered, but they are the only providers required to have their payments routed through a third party such as a physician or hospital. In rural areas where doctors may be more scarce than in urban or suburban areas, this bill could make hiring physician assistants easier and reduce the wait time for care.

A third, the Reducing Unnecessary Senior Hospitalization (RUSH) Act, will be introduced later this month with the goal of bringing technological innovation to Medicare. This bill will allow the use of technologies such as telehealth in skilled nursing facilities to treat patients in place rather than transferring them to a hospital. Telehealth gives medical professionals and first responders like those already working in skilled nursing facilities access to doctors who can provide immediate consultation in emergency situations, when appropriate. This could not only provide for quicker diagnoses and avoid costly ambulance trips, but also prevent Medicare beneficiaries from experiencing unnecessary risks such as falls, delirium, infections, and adverse medication interactions.

All three of these initiatives enjoy broad, bipartisan support and would make a measurable difference in the lives of millions of Americans across the country, especially in rural areas. As the baby boomers continue to retire, a larger percentage of the already growing population in our country will look to Medicare for health coverage. It is now more important than ever that we take advantage of every opportunity to improve access to care while working to reduce costs and focus resources where they are most impactful.